"Neglected" diseases but unrecognised successes: challenges and opportunities for infectious disease control

This article, published in the Lancet, argues that the focus of health policymakers and politicians on HIV/AIDS, tuberculosis and malaria, together with emerging and re-emerging diseases, causes funding for other diseases to be neglected. Many of the world’s poorest suffer or are at risk from these "neglected" diseases, despite the availability of cost-effective, stable and successful control or elimination interventions.

These "neglected" diseases are the viral, bacterial and parasitic infections of the tropics, together with acute respiratory infections and diarrhoeal diseases of children. The article examines their successful elimination in some parts of the world. It discusses the relevance of factors such as the biological stability of a disease, and the likelihood of drug and insecticide resistance developing, to the success in controlling the disease, and highlights the problems presented by malaria. It covers the benefits of disease-specific interventions but also the advantages of a more integrated approach. It concludes that a small investment in proven, cost-effective interventions against neglected diseases, preferably from the Global Fund to fight AIDS, Tuberculosis and Malaria, will bring wide-reaching benefits.

The article’s findings include the following:

• The most significant characteristic of the neglected diseases is their relative biological stability, making them much easier to control than HIV and AIDS, tuberculosis and malaria.
• Controlling neglected diseases is cost-effective: the estimated annual rates of return on investment in control of disabling diseases are about 14 to 30 per cent (for example, $1 invested in control of Chagas’ disease in Brazil produces a return of $7.16).
• Factors in successful control programmes for neglected diseases include: national government and donor commitment; realistic time frames; use of targeted effective interventions; establishment of long-term stable financing; drug or commodity donation programmes; monitoring and evaluation systems; and absence of drug or insecticide resistance in target organisms.
• Interventions using donated drugs or products have been sustained in conflict and post-conflict environments: for example, ceasefires in Sudan and Afghanistan were organised around the guinea worm eradication campaign and polio immunisation respectively.

The author draws the following conclusions:

• To ensure the efficient use of the substantial resources required to reduce morbidity and mortality associated with HIV/AIDS, tuberculosis and malaria, a small investment in proven, cost-effective interventions against neglected diseases - preferably from the Global Fund resources - will bring sustainable public health benefits, integrate well with and strengthen the health system, reduce disabling conditions, and bring collateral benefits to the health of the poorest nations.
• Policymakers need to articulate more actively the opportunities which exist for a more integrated approach, such as, for example, insecticide-treated bednets to control transmission of malaria and other diseases simultaneously.
• Policymakers are ignoring evidence that interventions against neglected diseases are effective. Current policies could perpetuate inequity, disrupt health financing policies, divert human resources from achievable goals and deny opportunities for impoverished health systems to improve.
• Further, resources are being transferred to interventions against the big three diseases that realistically have only a limited chance of success as they are reactive and do not adequately control transmission.

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